Research on the Experiences of Women in Surgery

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As a new generation enters surgery and as the number of women in the field is (slowly) increasing, one could hope that this also changes surgical culture. But does it? Judith Belle Brown and colleagues asked themselves exactly this question and conducted an interview study with academic surgeons.

Despite the fact that women still reported more struggles to achieve a good work-life-balance, participants overall noted that surgical culture was indeed changing and that surgeons were no longer expected to devote every waking hour to their jobs. For example, one participant noted: “I think things have changed over the years…I mean surgery in the past has been you just work hard, this is your life, and I think it’s changing a little bit … you are allowed to have a life outside. I think that’s good.”

Moreover, participants stated that this change did not only affect attitudes towards work-life-balance in general, but also attitudes towards childcaring responsibilities. One surgeon said: “I think the younger male colleagues, like my generation, it’s a bit different. We’re seeing more and more male surgeons who are doing more stuff at home … and they’re also having to leave early to pick up their kids because their wife is working too… So it’s changing. It’s not like how it used to be, 20 or 30 years ago.”

Concerns about childcare are an often cited reason for women to leave (or never enter) male-dominated fields such as surgery – and these concerns need to be addressed. However, a recent study by Nadya Fouad suggests that childcare concerns might not be the main culprit that drives women away.

In her survey with women who held engineering degrees the author found that most women who had left engineering had not done so in order to stay at home and raise a family but had rather left the industry to work someplace else. Moreover, the reason these women cited were very similar to those that men usually cite for leaving their jobs – inhospitable work climate and a lack of opportunities for career advancement (although caregiving responsibilities were also an often cited reason).

This demonstrates once again that leaving certain occupations is not due to some inherent lack of interest among women. On the contrary, women and men are looking for quite similar things in their careers – but men might just have an easier time achieving these goals in male-dominated fields.

Gender discrimination has obvious negative effects such as keeping women from rising to leadership positions or achieving equal pay. That alone should be enough reason to address these issues but there is also evidence that demonstrates the negative impact of perceived gender discrimination on women’s motivation – one of the key ingredients to high quality work.

Sharon Foley and colleagues investigated these issues in a sample of solicitors. Not surprisingly, they found that women perceived higher levels of gender bias against women and more personal gender discrimination compared to their male counterparts. This perceived personal gender discrimination was directly linked to two important motivational outcomes. First, it predicted solicitors’ organisational committment, and second, higher perceived gender discrimination was associated with higher intentions to leave the organisation.

This study shows how important gender equality is not just for its own sake but also for keeping women motivated and committed and ultimately ensuring that their talent and expertise is not lost.

There is a lot of research on how women in male-dominated areas (e.g. management or politics) are in a somewhat “damned if you do, damned if you don’t” situation. When they present themselves in a warm and feminine way their demeanor is at odds with what the field requires (e.g. they’re not perceived as “real leaders”), but if they present themselves in a masculine, assertive way, they’re not perceived as “real women” and thus disliked. So is that also the case in surgery? A recent study by Marie Dusch and colleagues suggests that this may not necessarily be the case, at least not from the patients’ perspective.

They presented patients in a general hospital with short scenarios describing either a male or a female surgeon who presented themselves in either a feminine or masculine way. Moreover, they were described as either performing breast cancer surgery or lung cancer surgery. Somewhat surprisingly (at least to me) patients did in general not prefer male surgeons over female surgeons or masculine surgeons over feminine ones. Neither did they prefer masculine male surgeons to feminine male surgeons or feminine female surgeons to masculine female surgeons – nor the opposite. In fact, the only significant result they found was that for lung cancer surgery, masculine surgeons were seen as more competent regardless of gender.

While it is important to replicate these results before drawing strong conclusions, this study nevertheless shows that gender stereotypes in surgery may be slowly changing or at least not be as pervasive among patients as we might assume.

I’m still on vacation (we all know how important work-life-balance is!), so this week another awesome colleague of mine, Hanne Watkins from the University of Melbourne, is filling in and reflecting on role models and conflicting goals in the male-dominated world of academia.

I had gotten pretty far in my academic career – all the way to Honours – before I had a female role model. The fact surprised me then, and troubles me now. Had I really gone through all of High School and undergrad without having a female professional to look up to?

It is also possible, however, that I did have female role models before that, but that I hadn’t realised they were female. It sounds silly when I put it like that, but I think I can explain. Prior to my Honours year, I might have had role models – teachers, writers, researchers, politicians – who I looked up to as figureheads in their respective professional and public domains, but where their gender (and mine) was irrelevant to their position as “my role model”.

But regardless. In Honours, the gender of my role model was suddenly relevant. She (let’s call her K) was a lecturer at my uni; she was smart and friendly and gave me career advice. These are all (arguably) gender-neutral activities, so I don’t want to overstate the centrality of the gender aspect of her role. Gender became salient to me, however, for two reasons. First, because K herself often talked about gender, feminism, and academia. Second, because she was over forty, single, and childless.

Going by cultural stereotypes, “forty, single, and childless” sounds like a woman’s nightmare. But K wasn’t living a nightmare. She was happy, she was an academic, she was smart and friendly and gave me career advice – and I wanted to be like her. Prior to meeting K, I had on some (mostly unconscious) level assumed that children would inevitably enter the picture at some point in my future. She freed me from that illusion, by showing me an alternative reality; a reality I wanted for myself as well, and which, thanks to her, looked achievable! Maybe it doesn’t sound like much, but at the time it was something of a revelation.

I’m not overly familiar with research on role models. But, I believe one theory suggests that for role models to “work”, you first have to have a desired goal, then you have to see someone who has achieved that goal, and then you have to perceive a “fit” between yourself and that person. (And some of the causal arrows probably go in both directions.) K ticked all the boxes. I wanted to be a childless academic in the future, K was that person now, and I was like K in that we were both female. (And, you know, smart and friendly and fond of dispensing advice. 😉 )

For a while, things were going along swimmingly.

Then, something dramatic happened: I started to want to have kids.

By that stage I had met lots of other amazing female academics, some of them older than me, some of them not; some of them with kids, some of them without. So you’d think I could find a role model among them, right?

Unfortunately, it hasn’t been that simple (surprise surprise). Thinking about the research on role models, however, has made me ponder how my predicament can be understood through the theory of role models I described above.

I have two desired goals: have children, and be an academic. I’m not willing to give up either goal, which means my combined goal is to be an academic who has children. As I said above, I have met plenty of women (and men!) who have achieved that goal. However, I wouldn’t describe any of them as my role model for this combined goal. Instead, it’s as if my goals obstinately generate their own, separate, role models.

On the one hand, I aspire to be like some awesome academics I know; whether they have children or not seems irrelevant. With some of them, I perceive a fit – they are “like me” in some ways, and so they are the ones I would call my role models, and they are the ones who inspire and motivate me.

On the other hand, I aspire to be like some awesome mothers I know; what else they do seems irrelevant. Unfortunately, with none of these do I perceive a fit – because none of them are academics. This makes me feel as if my goal of being a mother is incompatible with being an academic, even if, as I said above, I know this isn’t true.

So. In some ways, what I have just written is just another version of the “oh no I have conflicting goals and I will have to find a way to compromise”-dilemma. So I’m sorry that it’s old news.

However, I think the new news, to me at least, is that the theory of role models can help me understand why these goals of mine seem to conflict at such a deep level.

Sometimes, the parenting-working conflict seems to be portrayed as a matter of time-management, organisation, and communication – certainly challenging, but relatively “superficial” things. Seeing the conflict as one between competing role models, however, suggests that it’s not just a about what I might want to do to achieve my goals. It is about who I want to be.

As I am currently on vacation, my lovely colleague Helena Radke from the University of Queensland has agreed to step in and provide this week’s post. Thanks a lot, Helena, and to the rest of you: enjoy.

There are many reasons why women might not feel comfortable speaking up about gender discrimination in the workplace. One reason why women might not want to attribute an outcome to discrimination is because they experience disapproval from others when doing so. Regrettably this apprehension is not unsubstantiated. Social psychological research conducted by Kaiser and Miller (2001) has found that a person who attributes their treatment to discrimination (in this case an African American student failing a test) is evaluated more negatively than someone who does not attribute their treatment to discrimination even when it is clear that the person is being discriminated against. This is why, while many women say that they would confront sexism when presented with a hypothetical scenarios of discrimination, they are actually much less likely to do so in real life (Swim & Hyers, 1999).

So how can we ensure that women feel comfortable speaking up about instances of discrimination? One way in which we can answer this questions is by considering gender discrimination in the workplace to be a microaggression. According to Professor Derald Wing Sue from Columbia University, microaggressions are a brief and commonplace instances of indignity which, either intentionally or unintentionally, communicate hostile slights towards another person because of the social groups they belong to (Sue, 2007). He argues that they can be overcome by being aware of our own biases, knowing that our reality is different to others reality, not being defensive when someone reveals an incident of discrimination, discussing our own biases and being an ally against discrimination (see this video). Creating an organisational climate which is aware of the microaggressions women experience could be one way in which we can overcome the barriers women face to confronting gender discrimination in the workplace.

Stereotype threat is a psychological phenomenon in which people feel at risk of confirming a negative stereotype about their group, even if they don’t believe the stereotype to be true. For example, a woman might be confident in her math abilities and the math abilities of other women, but still be aware of the stereotype that women aren’t good at math. This feeling of anxiousness is then associated with lower performance.

An interesting study by Katherine Woolf and colleagues suggests that in medical education, students of Asian origin might experience a different kind of stereoype threat. While they are perceived as smart and studious, they are also seen as too quiet and not good at interacting with patients. Moreover, they are often seen as being forced into medicine by their parents, all of which can lead to stereotype threat among them. For example, one teacher notes “Students that are of South Asian or Indian origin, tend to be, or come across as being far more academically knowledgeable and they can justify what they’re doing and they’re very very bright, but actually putting that into practice and both with communication and practical skills doesn’t seem to gel that well”. The study further suggests that Asian medical students are aware of these negative stereoypes and that this does influence their behavior. The auhors illlustrate this with the example of one of the Asian students in their study: “she recalled hearing clinical teachers talking about the number of students from ethnic minorities at medical school and how she believed that teachers presumed that as an Asian student with medical parents she had been forced into medicine (the stereotype). She perceived they purposely made life harder for her, resulting in her feeling under psychological pressure (stereotype threat) and forced to prove that she was worthy of being at medical school. To prevent people making stereotypical assumptions about her she avoided telling people about herself.”

Initiatives aiming at addressing the under-representation of women in certain domains often include flexible or part-time working arrangements. The idea behind this seems to be that women often find it harder – and more important – to achieve a good work-life-balance, while other career goals such as prestige and a high salary are important to men.This of course makes sense, as women still take over a disproportionate amount of childcare and household work, while men are still seen as being the main earner of the family’s income. But times are changing – so is it really still the case that men’s and women’s career goals are that different?

A study that we conducted with academic staff at the University fo Exeter indicates that this isn’t necessarily the case. We asked them to rate the importance of different career goals on a scale from 1 to 7 and as you can see in the figure below, patterns were pretty similar for men and women. So it seems that it isn’t so much that women and men (at least in our sample) have different goals – but it might still be harder for women to achieve some of them.

The fields of science, technology, engineering, mathematics and medicine are often constructed as fields in which scientific ability is all that matters for success. Topics such as gender and race are often not discussed despite the fact that the majority of members of those fields are still white men. An interesting interview study by Angela Johnson illustrates how this construction of science as a meritocracy can negatively impact minorities, namely female science students of colour in the US.

The author acknowledges the good intentions of constructing science as a race and gender neutral field – because none of these variables should matter, but she also highlights that this can have negative, unintended consequences as it makes gender and race topics that cannot be openly discussed. She notes: “Belief in the meritocracy of science made the way that some laboratories were divided by race and ethnicity seem like a matter of personal choice (which, in a sense, it probably was). When students felt otherwise (…) there was no room for these suspicions within the race-neutral culture of science.”

This unintended, but also unaddressed, segregation of minority students is especially important in the light of findings that suggest that a lack of fit and belonging in a field has severe negative consequences for motivation and career intentions.

We’ve highlighted the importance of role models in general and female role models in particular in a number of quite a few of our past posts. Research suggests that role models serve different functions and lead to different outcomes and that gender is not necessarily important for all of them. However, other studies suggest that gender does matter, especialy in domains in women are under-represented, and one reason why that might be the case is that they can change stereotypes.

STEM/M fields in general and surgery in particular are stereotypically associated with men and maleness. The first person one might imagine when thinking about a surgeon is likely to be a man and when asked to describe a surgeon, stereotypically masculine traits such as “cold” might be used. The so called Stereotype Inoculation Model developed by Nilanjala Dasgupta argues that role models might act as a “social vaccine” and inoculate against these stereotypes which prevent women from entering or staying in STEM/M fields.

She proposes that when exposed to other minority members in one’s domain (e.g. other women in surgery), minority members can identify with this person, which then leads to changes in stereotypes and a stronger identification with the field (e.g. with surgery), but also a more positive attitude towards the field, social belonging in the field, perceived threat and one’s perceptions of one’s own abilities.

Thus, while male role models might be just as effective in some regards (e.g. for learning by emulation), visible female role models in surgery are important – not just for those women already on their path to becoming surgeons, but also for those who might not have made their career choices yet.